Teens' Alcohol Problems

Alcohol and the Family

Alcoholism is a disease of the family. Not only is there a significant
genetic component that is passed from generation to generation, but
the drinking problems of a single family member affect all other family
members. The family environment and genetics can perpetuate a vicious
and destructive cycle.

Many marriages break up over a husband’s or wife’s drinking.
Domestic violence typically erupts when one or both spouses have been
drinking, and drinking makes domestic violence more dangerous.

Families play a critical role in recovery from alcoholism. They can
be instrumental in encouraging a family member with alcoholism to seek
treatment. Strong family support also increases the chances for successful
recovery.

Alcoholism and Problem Drinking Pervasive in Family Life

More than half of adults have a close family member who has had alcoholism
or is still dealing with alcoholism.

Approximately one in four children younger than 18 is exposed to alcoholism
or problem drinking in the family.

A Factor in Many Serious Family Problems

Separated and divorced men and women are three times as likely to
say their spouse was alcoholic or had a drinking problem than men and
women who are still married.

Some 75 percent of husbands or wives who abuse their spouses have
been drinking prior to or at the time of the abuse.

Women who have heavy drinking husbands or partners are at higher risk
for developing their own drinking problems.

Each year between 1,200 and 8,800 babies are born with the physical
signs and intellectual disabilities associated with fetal alcohol syndrome
(FAS), and thousands more experience the somewhat lesser disabilities
of fetal alcohol effects. FAS is the leading preventable cause of mental
retardation in the United States.

Children of alcoholics are at high risk for developing problems with
alcohol and other drugs; they often do poorly at school, live with pervasive
tension and stress, have high levels of anxiety and depression and experience
coping problems.

Underage Drinking Challenges American Youth

First use of alcohol typically begins around age 13. By their senior
year, 64 percent of high school students say they have been drunk at
least once; 33 percent say they have been drunk in the past month.

Among teenagers between the ages of 12 and 17 who say they drink heavily
(five or more drinks on five or more occasions in the past month); 77
percent had at least one serious problem related to drinking in the
past year; 63 percent had built up tolerance to the effects of alcohol;
20 percent reported psychological problems related to their drinking;
12 percent reported health problems related to their drinking.

Teenagers who drink heavily are more likely to cut class or skip school,
perform poorly in school, take sexual risks, and commit suicide. Heavy
drinking increases the likelihood of delinquent and violent behavior
including running away from home, fighting, vandalizing property, stealing
and getting arrested.

Attitudes in the Home Influence Youth Drinking

Even in families where alcoholism isn’t present, permissive
attitudes about alcohol can have a profound impact on youth. Though
far more kids drink than use illicit drugs, parents are more likely
to excuse getting drunk as a “rite of passage.” Unless a
car is involved, some just don’t take it seriously.

Parents who drink and who have favorable attitudes about alcohol encourage
children to start drinking and to keep drinking.

Drinking by older siblings can influence the alcohol use of younger
siblings, particularly for same-sex siblings.

Sources: U.S. Department of Health and Human Services,
National Institute on Alcohol Abuse and Alcoholism, “Youth Drinking:
Risk Factors and Other Consequences,” Alcohol Alert No. 37, July
1997.

Dawson, D.A., & Grant, B.F., “Family history of alcoholism
and gender: Their combined effects on DSM-IV alcohol dependence and major
depression,” Journal of Studies on Alcohol, 59(1):97-106,
1998.

Greenblatt, JC., “Patterns of Alcohol Use Among Adolescents and
Associations with Emotional and Behavioral Problems,” U.S. Department
of Health and Human Services, Substance Abuse and Mental Health Services
Administration, March 2000.

Greenfeld L, “Alcohol and Crime: An Analysis of National Data on
the Prevalence of Alcohol Involvement in Crime,” Bureau of Justice
Statistics, Report # NCJ-168632, 1998.

U.S. Department of Health and Human Services, National Institute on Alcohol
Abuse and Alcoholism, “10th Special Report to the U.S. Congress
on Alcohol and Health: Highlights from Current Research,” June 2000.

U.S. Department of Health and Human Services, National Institute on Alcohol
Abuse and Alcoholism, “Drinking in the United States: Main Findings
from the 1992 National Longitudinal Alcohol Epidemiologic Survey,” 1998.

National Institute on Drug Abuse, “Monitoring the Future: National
Results on Adolescent Drug Use, Overview of Key Findings,” 2001.

National Council on Alcoholism and Drug Dependence, Inc., “Youth,
Alcohol and Other Drugs Fact Sheet,” December 1999.

December 2002

Teens' Serious Alcohol Problems

Introduction

Recent studies agree: most young people experiment with alcohol. By the time they are seniors in high school, 58 percent report they have been drunk 1 even though they can't drink legally until they are 21. Their drinking typically accelerates when they go away to college where 40 percent of students say that they binge on alcohol (for young men this means drinking five or more drinks in a row; for young women, four or more drinks in a row).2

Most of the young people who get drunk or binge gradually outgrow this dangerous behavior as they become adults with jobs and family responsibilities. If they're lucky, they may simply miss a class or two because of a hangover. Others experience more serious problems that alter their lives in significant ways: premature death, injury, smoking and using illicit drugs, academic failure, arrest, unplanned pregnancy and sexually transmitted disease all are associated with drinking among young people.

Some 3 million young Americans will develop an serious alcohol problem that will significantly increase their risk for experiencing one of these life altering problems. According to the federal government, compared to their peers without an alcohol drug use disorder, young people with drinking problems:

require emergency room medical care 47 percent more often

miss two more weeks of school

are 10 times more likely to be diagnosed with another drug use disorder

are 10 times more likely to drive under the influence of alcohol and/or other drugs

are four times more likely to be arrested or booked for breaking the law

are two and a half times as likely to run away or sleep on the streets

Alcohol Interferes With Maturation

As serious as these problems are — for the individuals who experience them and for their families and communities — they fail to convey how alcohol problems interfere with young people's bodies and minds, which haven't yet had a chance to fully mature. serious alcohol problems stunt emotional development by masking the stress and anxiety that can be a normal part of adolescence, robbing young people of the opportunity to develop the coping skills they will need to succeed later in life. In short, even if they escape serious physical harm, alcohol problems prevent young people from achieving their full potential as adults in ways that aren't easily quantified.

Young people with serious alcohol problems — many of whom also have mental health disorders that make their drinking and other drug use much more problematic — are among the most vulnerable in our society. They need treatment. But the vast majority — 83 percent, on average — isn't getting it, and among those who do, only 25 percent get enough. 3

The benefits of treatment for young people, as well as society, are enormous. Recent clinical research proves that effective treatment developed specifically for adolescents can help them get their lives back on track through:

considerable reductions in their use of alcohol and marijuana one year after treatment

significantly fewer problems associated with their drinking and other drug use

What Are Serious Alcohol Problems?

Serious alcohol problems fall into two categories: alcohol dependence and alcohol abuse. Together, these behaviors are known among experts as alcohol use disorders. The American Psychiatric Association (APA) publishes standardized criteria for diagnosing each of these conditions according to the presence of certain symptoms. This calculator uses these criteria to estimate how many young people in the U.S. need treatment.

However, the APA developed these criteria for adults, not adolescents, which means they may miss many young people who would benefit from an intervention of some kind. Though serious alcohol problems can develop within a year or two after a young person has begun drinking,4 alcohol-related medical problems and withdrawal syndrome, which take years to develop, are symptoms that are much more likely to be found among adults. Nor do these criteria address factors unique to young people, whose bodies and minds continue to undergo profound changes throughout adolescence.

As a result, some researchers have suggested that serious alcohol problems should be assessed more broadly among young people to permit earlier and more targeted interventions along a continuum facilitated by more widespread use of screening. These assessments would be multidimensional and take a number of other factors into consideration, including:

Age

Example: A 13-year-old who is binge drinking and smoking marijuana probably signals a more immediate need for intervention than an 18-year-old whose similar behavior, while dangerous and illegal, may be more typical of his age group.

The amount, frequency and context of alcohol and other drug use

Example: Any young person who drinks every day before going to school or during the school day.

The seriousness and nature of the problems being experienced by a young person

Example: A young person who fails a grade, runs away from home or comes into contact with the juvenile justice system.

The presence of a mental health problem

(see following section)

A family history of addiction

Example: Having a parent with an alcohol use disorder greatly increases the chances that an individual will develop one at some point in their life. Researchers have established that the risk for developing an alcohol use disorder is approximately 50 to 60 percent genetic.

Who Is at Risk?

Researchers estimate that people who begin drinking before the age of 15 are four times more likely to develop an serious alcohol problem later in life than those who wait until they are 21. 5 Less well understood, however, is the issue of who will develop an alcohol problem while they are still in adolescence, although scientists have identified several risk factors.

Many young people with alcohol problems also have a mental health, or co-occurring, disorder. According to the American Academy of Pediatrics, estimates range from 41 to 65 percent.6 As a result, these young people are at especially high risk for two of the most serious problems associated with drinking during adolescence: violence and suicide. 7

Children with conduct disorders — also known as antisocial disorders and characterized by rule-breaking behavior and a disregard for the rights of others — are at extremely high risk for developing an serious alcohol problem during adolescence. Thrill-seeking is common among children with conduct disorder and may explain why they begin drinking at an early age. Researchers also believe that alcohol's role in loosening inhibitions may encourage such adolescents to "act out" and get them in more serious trouble because of their drinking. Other researchers suggest serious alcohol problems and conduct disorders co-occur because of shared risk factors, not because one influences the other.8

Depression and post-traumatic stress disorder — also known as negative-affect disorders — are also common among adolescents with serious alcohol problems, especially young women. Researchers believe that both of these conditions often occur as a result of physical or sexual abuse during childhood and that young people who have been (or are being) victimized drink to self-medicate.9 As with conduct disorders, however, exactly how one influences the other isn't known. Because alcohol is a depressant, its use can contribute to depression. Studies also have shown drinking can increase the likelihood of sexual victimization that, in turn, can lead to a negative-affect disorder.

Other Characteristics Linked to Alcohol Problems

The link between attention deficit/hyperactivity disorder (ADHD) and adolescent alcohol problems has not been as strongly established. Recent research, however, suggests that children who are diagnosed with severe inattention problems also face an increased risk for drug use disorders during their teen years.10

Experts have identified a number of other risk factors for serious alcohol problems, most of which have to do with a young person's environment. Young people who have strong relationships with their parents are less likely to have serious alcohol problems than those who don't. Poor parenting skills and parental problems with mental health and alcohol or other drug use are other contributing factors. 11 Unstable living arrangements and the influence of siblings and other family members or friends who may drink heavily and use drugs also can increase the risk.

Just as important as risk factors are protective factors - variables that have been identified by researchers that can be strengthened during treatment to prevent relapse. These include: 12

success in school or work

friendships with peers who don't drink or use other drugs

healthy family relationships

involvement in positive recreational activities

Access to Treatment

Young people usually don't get treatment for alcohol and other drug use disorders until their drinking has gotten them in trouble with the law. In fact, 44 percent of young people in treatment have been referred by the criminal justice system.

Other sources of referral include:

School/Community Agency (22%)

Self/Family (17%)

Other Substance Abuse Treatment Agency (5%)

Other Health Care Provider (5%)

Other (16%)

The nation's health care system doesn't identify or treat young people with alcohol and other drug use problems any better than it does adults. Because of longstanding relationships with their young patients, pediatricians and family practice physicians are ideally positioned to observe the changes in behavior and health that occur as a result of drinking and drug use. But while the American Medical Association recommends that health professionals ask their young patients about their alcohol and drug use on an annual basis, fewer than 50 percent of physicians screen these patients for this purpose.13

Unique Treatment Needs

Treatment for alcohol and other drug use disorders among young people has advanced considerably in the past several years. Within the next year or two, clinicians will be able to choose among a dozen therapies whose effectiveness and cost benefits have been established by research.14 This progress has been stimulated in part by necessity: during the 1990s, the number of young people seeking drug treatment rose by 50 percent.15

Researchers learned that treating young people in programs for adults didn't work. In some cases, it may even have caused their drug use to escalate once they were discharged.16

Acknowledging the considerable differences between adolescent and adult drug use disorders was the first step in developing age appropriate treatment:

The patterns of drug use among young people differ: they drink more alcohol and smoke more marijuana than adults. They also are more likely to binge drink or get high whenever an opportunity arises.

Young people have higher rates of mental health disorders and get into trouble more often than adults. They require more careful assessment for mental health disorders which, if present, must be treated appropriately.

Young people are increasingly influenced by their peers and shaped by the pressures encountered in social institutions such as school and the criminal justice and welfare systems. These influences and pressures contribute not only to the development of serious alcohol problems, but also have a profound impact on treatment.

The gains young people make during treatment may be undercut when they are return to an unhealthy atmosphere at home, in their neighborhoods or at school. They do not always have access to age-appropriate support groups. This explains why they have higher relapse rates than adults and typically require three or four treatment episodes before achieving recovery.

Notes:

1 2002 Monitoring the Future Survey, University of Michigan, Institute for Social Research.

14 Dennis, M.L. 2002. Treatment Research on Adolescent Drug and Alcohol Abuse: Despite Progress, Many Challenges Remain. Connection, a publication of the Academy for Health Services Research and Health Policy.

Problems at School

Problem Drinking Affects School Performance

How does problem drinking affect young people's schooling? In some cases the linkage between problem drinking and academic performance is profound. Drinking can affect the biological development of young people as well as their school-related achievement and behavior.

Serious alcohol use among youth has significant neurological consequences. Alcohol damages areas of the brain responsible for learning and memory, verbal skills and visual-spatial cognition. 1, 2 Diagnosticians often find that these skills in adolescents who drink are deficient in comparison to those who aren't drinking.

Scientists know that alcohol problems are tied to lower grades, poor attendance and increases in dropout rates. The 2000 National Household Survey on Drug Abuse (NHSDA - now known as the National Survey on Drug Use and Health), a federal study, found that as rates of alcohol use by 12- to 17-year-olds increase, grade point averages decrease. 3 Middle school students whose peers avoid using alcohol and other drugs score higher on state reading and math tests than other students. 4

In any given age group, heavy and binge drinkers are 4-6 times more likely than nondrinkers to say they cut classes or skipped school. They are twice as likely as nondrinkers to say that their school work is poor, and they report more frequently that they are disobedient at school.5 Among high school students, those who use alcohol are five times more likely to drop out than those who don't use alcohol.6 These problems are not limited to the middle and high school setting; hangovers and drinking by college students lead to missed classes and falling behind in school work.7 Alcohol is implicated in more than 40 percent of all college academic problems and in 28 percent of all college dropouts.8